Rotational Atherectomy for Ablation of Multiple Channel Structure Observed by Optical Frequency Domain Imaging

Abstract

Patient: Male, 71Final Diagnosis: Silent myocardial infarctionSymptoms: DynpneaMedication: —Clinical Procedure: —Specialty: CardiologyObjective:Unusual or unexpected effect of treatmentBackground:Previous case reports have shown that regardless of the etiology, multiple channel structures can be treated successfully by routine percutaneous coronary intervention. However, there are no general recommendations for intervention because multiple channel structures are complex and rarely diagnosed.Case Report:A 71-year-old male was admitted to our hospital due to bronchial pneumonia. After admission, the patient experienced acute decompensated heart failure. Coronary angiogram revealed 3 diseased vessels with heavy calcification. Although the patient’s syntax score was high, we performed percutaneous coronary intervention (PCI) on each vessel based on his request and in consideration of his dementia. After PCI for the left circumflex and descending arteries, we performed PCI for the right coronary artery (RCA) using optical frequency domain imaging (OFDI). A multiple channel structure and calcified nodule were observed by OFDI. We performed rotational atherectomy (RA) on the RCA, and the 2 structures were ablated. After RA, we dilated the lesions with a scoring balloon and deployed a drug-eluting stent.Conclusions:RA was effective in ablating partition walls of the multiple channel structure observed using OFDI.

Diagnosis and treatment of angiographically unclear coronary lesions

“…There are hypotheses regarding dissection and inflammation as complications of atherosclerotic plaques as well as hypotheses regarding thrombus recanalization and neovascularization, tissue substitution after spontaneous dissection, and cardioembolic origin. 2–4,11 The literature indicates that such structures occur more often in men than women, at an average age of approximately 50 years, and in active smokers with an average of >20 cigarettes per day; these data are consistent with our case report. Smoking is considered to be the main trigger for the formation of such lesions because smoking causes endothelial dysfunction and increased prothrombotic activity of platelets.…”